HomeMy WebLinkAboutCLE201600126 Application 2016-06-06Application for Zoi
CLE # XY
PLEASE REVIEW ALL 3 SHEETS
mg Clearance
oFtt CE USE Y f
check 0 6 Date:
Receipt # Staff:
PARCEL INFORMATION
Tax Map and Parcel: 76A/101 Existing ZOAML—_
Parcel Owner: The Rector and Visitors of the University of Virginia
Parcel Address•?st Floor Barringer Wing, Hospital Drive City Charlottesville State VA —Zip 22903
(include suite or floor)
PRIMARY CONTACT
Who should we calVwrite concerning this project? Licensing Dept
Address
1 Park Place City Annapolis StatoMb Zip 21401
Oflicc Phone: >
410 267-6111 Cell N Fax E-mail license@townepark.wrn
_- -
Check an ~ that apply: Change of ownership Change of use Cho nge of name x New business
Business Namefrype: Towne Park, LLC / Valet Parking & Parking Facility Management Services
Previous Business nn this site
Describe the proposed business Including use, number of employees, number of shifts, available parkIng spasm, number of
vehieles, and any additional information that YOU can provide; A i
"'Deis Clcarancc will only be valid on the parcel for which it is approved, lfyou change, intenslfy or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated an this application, 18130 ccrtilf that the information provided
is true and aceutafo to the best of rimy knowledge. I have read the conditions of approval, and I andcrstaad them, and that I will abide by them.
Signature Printctt
APPROVAL INFORMATION
Approved ea proposal [ I Approved with conditions j Acniod
] Backnow prevention device and/or current test data needed for this site. Corttad ACSA, 977-4511, x117.
[ 3 No physical site inspection has been done for this clearance. Therefore, it is not a determination of romPliance with the existing
site plan,
( j Titis site complies with the site plan as of this date.
Notes:
Building (Mcial .r : � =A Date
/ y _ -
Zoning Official Date C ale
Other Official R __ _ Date
County of Albemarle Departineuf of Community Davelaprnent
401 McIntire hoed Charlottcsvllie, VA 22902 Voice: (434) 296-S33 Fax.: (434) 972-4126
Revised 11/112015 Page 2 of
otake to complete the following:
Y I�
is use in Li, HIorPDIP Eoning? If $o, give applicant a Certified
Engit,cWs Report (CRR) packet.
Y !(
Will ero be fob preparation?
If so, give applicant a Health Department farm.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the out that applies
Is parcel an private well or nbllc Ovate .
If Private well, provide Heal nt forrn,
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that appli
Is parcel on septic u6itY cscrvei►7
Y I(R)
Will you be putting UP ai new sign of any kind? If so, obtain proper
Sign permit,
Permit # _
Y l
WilMore be any new construction nr reraav&+ians7
If so, obtain the proper Permit.
Permit tf
Violas ens:
Y/
If so, List:
YINV
If so, List:
Cleo Me":
Reviewer to complete the fallowing:
square footage of Use: .
, N g ���..
omitted as:
Under Section.
Supplementary regulations section:
Parking formula:
Required spaces:
Items to be verified in the field:
Inapeetur . Date: _
Notes:
FWflers:
YJ%)
.If so, List:
YrW
if so, List:
Revised 1 I 2Q 15 Page 3 bf 3
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